How should we react to headlines warning NHS finance directors and their colleagues elsewhere in the public sector that a swathe of private finance initiatives - including new hospitals - is under serious threat because of the recession?

With scepticism, I’d say.

Why? Partly because Gordon Brown’s ministers keep saying (rightly) that spending is needed to keep the recession from becoming a depression. It follows that public sector spending fills part of the gap created by the collapse of confidence in the private sector as we all tighten belts.

Government is the lender and spender of last resort and, if you worry about paying for it in the long run, rest assured that the alternative - protracted contraction and deflation - is worse.

Unwise spending

There is an obvious risk here of unwise projects being promoted. That happened in Japan’s long 1990s slump, when public works produced some useless bridges - hospitals too, I expect - without restoring confidence.

But that was true of some private finance projects before the storm broke on those reckless bankers in August 2007, and will be true when it is over.

The recession may provide a good excuse not to proceed with some daft schemes. But it will also allow ministers to reshape existing priorities: investing in green technologies, for example.

Did you notice that London mayor Boris Johnson’s plan for a£40bn Thames Estuary airport (no, I’m not endorsing it) would be energy self-sufficient by virtue of tide power? Such is the NHS’s future too and the recession provides a chance to give it a shove.

There is another obvious reason why private finance (55bn worth since 1992) will not only survive the financial tsunami, but might thrive. Everyone knows banks that offered credit cards to babies two years ago are now refusing to lend a fiver to billionaires because of uncertain risk.

But governments are safe unless David Cameron is right to suggest that Great Britain Plc is facing bankruptcy and a 1970s-style trip to the International Monetary Fund.

Ex-health secretary Ken “Bruiser” Clarke, now back in the shadow cabinet, contradicted that view on weekend TV. He is right.

A problem of perception

So private finance backers (investors have the cash, not the confidence) know they have a solid client and a guaranteed income stream, courtesy of the taxpayer, whether it is schools, clinics, houses or the 2012 Olympics. As one of Alan Johnson’s officials explained to me: “We have explained to reporters [that] these projects are much safer than other building projects.”

The next year or three will probably be awful. Jobs will be lost, services and pensions squeezed. But we will come through it and the public sector will be relatively secure.

I move on to the Commons debate on NHS accident and emergency services, which saw both sides falling over themselves to praise what shadow health secretary Andrew Lansley’s motion called the “expertise and dedication” of care staff.

Labour MPs routinely do this. From the Tory side it is a reminder that the Cameroons’ pre-election charm offensive includes hospital porters and managers as well as doctors.

Mr Lansley’s warmth did not extend to ministers, accused of undermining A&E and the ambulance service, and dithering about a single nationwide number for emergencies that are not quite of the 999 variety. He cited the recent College of Emergency Medicine report which called for 50 per cent more A&E consultants.

The more serious charge is that A&E restructuring into trauma, urgent care and minor injury centres is confusing the public, and increasing admissions is something Alan Johnson denies.

As asserted by Lansley’s deputy, Mike Penning, regionalised ambulance services are also failing on eight-minute response times, let alone the four-hour target time for treatment. Community first responders also feel undermined, MPs complained.

Harsh winter conditions have intensified pressure on emergency services in recent weeks, they add. True, but no one denies that things are much better than in 1997.